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Advanced Corneal Imaging in Keratoconus: A Report by the American Academy of Ophthalmology.

Publication ,  Journal Article
Kuo, AN; Cortina, MS; Greiner, MA; Li, JY; Miller, DD; Shtein, RM; Veldman, PB; Yin, J; Kim, SJ; Shen, JF
Published in: Ophthalmology
January 2024

PURPOSE: To review the published literature on the diagnostic capabilities of the newest generation of corneal imaging devices for the identification of keratoconus. METHODS: Corneal imaging devices studied included tomographic platforms (Scheimpflug photography, OCT) and functional biomechanical devices (imaging an air impulse on the cornea). A literature search in the PubMed database for English language studies was last conducted in February 2023. The search yielded 469 citations, which were reviewed in abstract form. Of these, 147 were relevant to the assessment objectives and underwent full-text review. Forty-five articles met the criteria for inclusion and were assigned a level of evidence rating by the panel methodologist. Twenty-six articles were rated level II, and 19 articles were rated level III. There were no level I evidence studies of corneal imaging for the diagnosis of keratoconus found in the literature. To provide a common cross-study outcome measure, diagnostic sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were extracted. (A perfect diagnostic test that identifies all cases properly has an AUC of 1.0.) RESULTS: For the detection of keratoconus, sensitivities for all devices and parameters (e.g., anterior or posterior corneal curvature, corneal thickness) ranged from 65% to 100%. The majority of studies and parameters had sensitivities greater than 90%. The AUCs ranged from 0.82 to 1.00, with the majority greater than 0.90. Combined indices that integrated multiple parameters had an AUC in the mid-0.90 range. Keratoconus suspect detection performance was lower with AUCs ranging from 0.66 to 0.99, but most devices and parameters had sensitivities less than 90%. CONCLUSIONS: Modern corneal imaging devices provide improved characterization of the cornea and are accurate in detecting keratoconus with high AUCs ranging from 0.82 to 1.00. The detection of keratoconus suspects is less accurate with AUCs ranging from 0.66 to 0.99. Parameters based on single anatomic locations had a wide range of AUCs. Studies with combined indices using more data and parameters consistently reported high AUCs. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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Published In

Ophthalmology

DOI

EISSN

1549-4713

Publication Date

January 2024

Volume

131

Issue

1

Start / End Page

107 / 121

Location

United States

Related Subject Headings

  • Tomography
  • ROC Curve
  • Ophthalmology & Optometry
  • Ophthalmology
  • Keratoconus
  • Humans
  • Corneal Topography
  • Corneal Pachymetry
  • Cornea
  • 3212 Ophthalmology and optometry
 

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Kuo, A. N., Cortina, M. S., Greiner, M. A., Li, J. Y., Miller, D. D., Shtein, R. M., … Shen, J. F. (2024). Advanced Corneal Imaging in Keratoconus: A Report by the American Academy of Ophthalmology. Ophthalmology, 131(1), 107–121. https://doi.org/10.1016/j.ophtha.2023.07.030
Kuo, Anthony N., Maria S. Cortina, Mark A. Greiner, Jennifer Y. Li, Darby D. Miller, Roni M. Shtein, Peter B. Veldman, Jia Yin, Stephen J. Kim, and Joanne F. Shen. “Advanced Corneal Imaging in Keratoconus: A Report by the American Academy of Ophthalmology.Ophthalmology 131, no. 1 (January 2024): 107–21. https://doi.org/10.1016/j.ophtha.2023.07.030.
Kuo AN, Cortina MS, Greiner MA, Li JY, Miller DD, Shtein RM, et al. Advanced Corneal Imaging in Keratoconus: A Report by the American Academy of Ophthalmology. Ophthalmology. 2024 Jan;131(1):107–21.
Kuo, Anthony N., et al. “Advanced Corneal Imaging in Keratoconus: A Report by the American Academy of Ophthalmology.Ophthalmology, vol. 131, no. 1, Jan. 2024, pp. 107–21. Pubmed, doi:10.1016/j.ophtha.2023.07.030.
Kuo AN, Cortina MS, Greiner MA, Li JY, Miller DD, Shtein RM, Veldman PB, Yin J, Kim SJ, Shen JF. Advanced Corneal Imaging in Keratoconus: A Report by the American Academy of Ophthalmology. Ophthalmology. 2024 Jan;131(1):107–121.
Journal cover image

Published In

Ophthalmology

DOI

EISSN

1549-4713

Publication Date

January 2024

Volume

131

Issue

1

Start / End Page

107 / 121

Location

United States

Related Subject Headings

  • Tomography
  • ROC Curve
  • Ophthalmology & Optometry
  • Ophthalmology
  • Keratoconus
  • Humans
  • Corneal Topography
  • Corneal Pachymetry
  • Cornea
  • 3212 Ophthalmology and optometry